雷珠单抗治疗视网膜分支静脉...体的状态变化及其对疗效影响_王硕.pdf

安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿过程中玻璃体的状态变化及其对疗效影响王硕，刘畅，贾雯，朱恺，王凯，李晓俊，顾永昊作者单位：蚌埠医学院研究生院，安徽 蚌埠233000通信作者：顾永昊，男，主任医师，硕士生导师，研究方向为眼科常见病、眼底病，Email：基金项目：安徽省自然科学基金项目（1908085MH254）摘要：目的 探讨雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿（branch retinal vein occlusion-macular edema，BRVO-ME）过程中玻璃体状态的动态变化及其对疗效的影响。方法 回顾性分析2021年26月在中国科学技术大学附属第一医院眼科接受玻璃体腔注射雷珠单抗治疗的初诊BRVO-ME病人35例35眼，根据间接眼底镜，B超及光学相干断层扫描（optical coherence tomography，OCT）结果对玻璃体状态进行评估，分为无PVD组17例，局限VMA组5例，广泛VMA组7例，完全PVD组6例。各组病人连续3月每月注射雷珠单抗1次，随访4个月以上，在每次注射1月后观察病人的玻璃体状态、黄斑厚度（central macular thickness，CMT）和最佳矫正视力（best corrected visual acuity，BCVA）。结果 35眼在治疗后BCVA和CMT均显著好转。各组病人在注药1次，2次，3次后的BCVA均差异无统计学意义。在第1次注药后，局限VMA组的CMT 452.00（433.50，591.50）m 与无PVD组 336.00（311.00，361.00）m，P=0.016、广泛VMA组 335.00（251.00，357.00）m，P=0.028 相比较差异明显。第2次注药后，局限VMA组的CMT 358.00（330.50，504.00）m 与无PVD组 259.00（235.00，291.00）m，P=0.021、广泛VMA组 237.00（233.00，278.00）m，P=0.036 相比较仍然差异较大。第3次注药后，各组间CMT差异无统计学意义。与未治疗时相比，第1次治疗（P=0.086）及第2次治疗后（P=0.057），各组病人的玻璃体状态差异无统计学意义。第3次治疗后，无PVD6眼，局限VMA5眼，广泛VMA9眼，完全PVD15眼，与未治疗时相比，无PVD组改变11眼，局限VMA组改变4眼，广泛VMA组改变7眼，完全PVD改变0眼，病人玻璃体状态较未治疗时差异有统计学意义（P=0.001）。结论 不同基线玻璃体状态的BRVO-ME病人，在经过3次玻璃体腔雷珠单抗注射治疗之后均能获得明显的视力获益和水肿消退。基线玻璃状态对病人视力无明显影响，局限VMA可能在治疗初期影响水肿消退，但在经过3次注射后即无明显差异。经过3次注射治疗后，病人玻璃体状态整体向后脱离方向发展。关键词：视网膜静脉闭塞；黄斑水肿；玻璃体后脱离；雷珠单抗Changes in the state of vitreous body during the treatment of BRVO-ME with ranibizumab and its effect on the efficacyWANG Shuo,LIU Chang,JIA Wen,ZHU Kai,WANG Kai,LI Xiaojun,GU YonghaoAuthor Affiliation:Graduate School,Bengbu Medical College,Bengbu,Anhui 233000,ChinaAbstract：Objective To investigate the dynamic changes of vitreous state in the treatment of macular edema secondary to branch retinal vein occlusion with Ranibizumab and its influence on the curative effect.Methods A retrospective study on thirty-five eyes of 35 newly diagnosed BRVO-ME patients who received intravitreal injection of ranibizumab in the Department of Ophthalmology,the First Affiliated Hospital of University of Science and Technology of China from February 2021 to June 2021 was conducted.The patients were divided into no PVD group(n=17),limited VMA group(n=5),extensive VMA group(n=7),and complete PVD group(n=6).Patients in each group were injected once a month within 3 months and followed up for more than 4 months.Vitreous status,macular thickness and best corrected visual acuity of patients were observed 1 month after each injection.Results BCVA and CMT were significantly improved in 35 eyes after treatment.There was no significant difference in BCVA in each group after injection 1,2 and 3times.After the first injection,the CMT of the VMA focal group 452.00(433.50,591.50)m was significantly higher than that of the no PVD group 336.00(311.00,361.00)m,P=0.016,the VMA broad group 335.00(251.00,357.00)m,P=0.028.After the second injection,the CMT of the VMA focal group 358.00(330.50,504.00)m was still significantly higher than that of the no PVD group 259.00(235.00,291.00)m,P=0.021,the VMA broad group 237.00(233.00,278.00)m,P=0.036.After the third injection,there was no significant difference in CMT among all groups.There was no significant difference in the vitreous status between the first treatment(P=0.086)and the second treatment(P=0.057).After the third treatment,no PVD was observed in 6 eyes,the VMA focal group in 5 eyes,the VMA broad group in 9 eyes,and complete PVD in 15 eyes.Compared with those before treatment,there were 11 药物与临床引用本文：王硕，刘畅，贾雯，等.雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿过程中玻璃体的状态变化及其对疗效影响 J.安徽医药，2023，27（7）：1466-1471.DOI：10.3969/j.issn.1009-6469.2023.07.042.1466安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）eyes with changes in the non-PVD group,4 eyes with changes in the VMA focal group,7 eyes with changes in the VMA broad group,and no eyes with changes in the complete PVD.There was a significant difference in the vitreous status between the patients without treatment and those without treatment(P=0.001).Conclusions Patients with BRVO-ME in different vitreous states achieve significant visual acuity benefit and edema resolution after 3 rounds of intravitreal Ranibizumab injection.Different glass states has no significant effect on patients visual acuity.VMA focal may affect edema resolution at the initial stage of treatment,but there is no significant difference after 3 injections.The vitreous state of the patient tends to develop into detachment after 3 times vitreous injection of Ranibizumab.Key words：Retinal vein occlusion;Macular edema;Posterior vitreous detachment;Ranibizumab视网膜分支静脉阻塞（branch retinal vein occlusion，BRVO）是一种常见的导致视功能障碍的视网膜血管病变，继发的黄斑水肿（macular edema，ME）可持续存在1-3，大多数病人的视力丧失和生活质量的下降都与黄斑水肿有关4-5。研究证明血管内皮生长因子（vascular endothelial growth factor，VEGF）在BRVO-ME中起重要的调控作用，玻璃体腔注射抗VEGF药物已成为临床治疗BRVO-ME的一线治疗方案6，7。玻璃体后脱离（posterior vitreous detachment，PVD）是指后部玻璃体皮质与视网膜内界膜的脱离，一般可分为：无玻璃体后脱离，部分性玻璃体后脱离，完全性玻璃体后脱离等8。而在PVD的发展变化过程中，上述分期并非逐级进展，临床中对PVD规范化诊疗及随访的重视程度相对有限9-10。病人玻璃体状态可影响多种眼底疾病的预后，如：年龄相关性黄斑变性（age-related macular degeneration，AMD），视 网 膜 静 脉 阻 塞